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Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umeå General Population Heart Study.

The aim of the present study was to describe regional and global right ventricular (RV) function in a wide age range of healthy subjects of both sexes. We studied 255 (125 females) healthy individuals randomly selected from the Umeå General Population Register, age 58 +/- 19 (range 22-89) years. RV function was studied using myocardial tissue Doppler imaging of the RV free wall. Isovolumic contraction (IVCv), systolic (Sv), early (Ev), and late (Av) diastolic velocities were measured. Furthermore, isovolumic periods and ejection time intervals were also measured. Conventional Doppler was used to study RV global filling properties. While systolic myocardial velocities were conserved over age, there was a decrease in myocardial E/A ratio with increasing age (r =-0.67, P < 0.001, for base) taken from the RV free wall. A similar age relation was found in RV global filling velocities with a reduced tricuspid E/A ratio (r =-0.57, P < 0.001). Furthermore, a significant correlation was found between global and regional E/A ratios at the basal (r = 0.58, P </= 0.001) and mid-segmental levels (r = 0.46, P </= 0.001). Systolic myocardial velocities behaved independent of age whereas regional as well as global E/A ratio were age-related. No relationship was found between regional isovolumic time intervals and age. Knowledge of these age-dependent relationships is fundamental when evaluating RV function in patients.

Adult↗

[The changes of right ventricular function in the course of COPD induced cor pulmonale].

A study on pulmonary hemodynamics, radionuclide right ventricular ejection fraction and blood gas analysis in 62 cases of COPD induced cor pulmonale at different stages showed the following results: 1. In early stage of cor pulmonale, stroke volume could not increase after exercise, it proved that cardiac reserve has been reduced; 2. With the progression of the disease, cardiac stroke volume reduced but cardiac output increased gradually, it could be considered as the evolutionary characteristic of cardiac function in chronic cor pulmonale; 3. The right ventricular stroke work was normal and could increase with the rise of after-load, reflecting the relatively effective functional compensation; 4. In acute exacerbation of cor pulmonale, the cardiac failure should be attributed to hyperdynamic type with hypervolemia; 5. Correlation analyses suggested that cardiac output decreased along with the increase of right ventricular afterload only in acute exacerbation of late cor pulmonale; PaO2 and PaCO2 have only slight influence on right ventricular function.

Adult↗

Evolutionary changes in left and right ventricular function in acute myocardial infarction.

To determine the evolutionary changes in right and left ventricular function in acute myocardial infarction, 3 serial gated blood pool scans were performed in 76 patients within 24 hours (24 H), at 10 days (10 D) and 3 months (3 M) following the onset of myocardial infarction. The patients were divided into 3 groups: ANT (anterior MI), INF (inferior MI without right ventricular dysfunction) and RVF (inferior MI with right ventricular dysfunction). LVEF in ANT was significantly lower than that of INF and RVF at 24 H, 10 D and 3 M. The ratio of right ventricular volume to LV volume (RVV/LVV) was compared among 3 groups. The mean values of RVV/LVV in RVF were 1.3 through 24 H and 3 M and they were significantly higher than the other two groups. The RVV/LVV in ANT and INF were around 1.0. LVEDVI in RVF was rather smaller than that of ANT and INF. LVESVI in ANT at 24 H was significantly larger than that of INF and RVF and the mean value of LVESVI in ANT were around 60 ml/M2 from 24 H to 3 M. LVEF in ANT, RVF and INF did not increase significantly during peak exercise at 3 M. However, quantitative regional wall motion analysis revealed that regional wall motion of R2 (posterolateral wall motion) in ANT and R5 (septal wall motion) in INF decreased significantly during peak exercise. These impairments in regional wall motion might be due to the exacerbation of ischemia of non-infarcted area.

Adult↗

[Right ventricular function in patients with rheumatic mitral valve stenosis. Effect of balloon mitral valvuloplasty].

UNLABELLED: Postrheumatic mitral stenosis might cause impairment of right ventricular (RV) function due to both an increase in RV afterload and rheumatic myocardial disease. Therefore, we investigated in 19 patients with postrheumatic mitral stenosis and sinus rhythm right ventricular volumes and hemodynamics by a computerized thermodilution catheter during rest and supine bicycle exercise. In 14 patients the investigation was repeated within 2 days after balloon mitral valvuloplasty. Resting RV ejection fraction was decreased (43 (15-53)%, median (range)) and correlated significantly with RV end-systolic volume index (r = -0.90), stroke volume index (r = 0.77), RV end-diastolic volume index (r = -0.76), heart rate (r = -0.69), pulmonary artery resistance (r = -0.69), and mean pulmonary artery pressure (r = -0.68). RV end-diastolic volume index was 107 (81-200) ml/m2. Exercise induced a decrease of RV ejection fraction to 36 (13-48)% at 50 Watt (p < 0.001), while it increased RV end-diastolic volume index to 131 (78-231) ml/m2 (p < 0.001). Balloon mitral valvuloplasty improved RV ejection fraction at rest from 41 (15-47)% to 48 (39-55)% (p < 0.005) and from 30 (13-46)% to 43 (27-56)% during exercise (p < 0.005). The increase of RV ejection fraction after valvuloplasty was caused by an increase in stroke volume, but not by a reduction in RV end-diastolic volume. CONCLUSION: Depending on the increased RV afterload, RV function is markedly depressed in mitral stenosis. An immediate and almost complete improvement of RV function occurs with the reduction of RV afterload after balloon mitral valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Evaluation of left and right ventricular functional parameters with automatic edge detection program of ECG gated blood SPET.

An analysis program for ECG gated, blood pool, single photon emission tomography (SPET GBP) is available. This program permits the automatic evaluation of left and right ventricular function, but its reliability has not been thoroughly assessed. The objective of this investigation was to examine the reliability of the parameters derived from SPET GBP. Fifty-three patients who had undergone both SPET GBP and planar, ECG gated, blood pool scintigraphy (planar GBP) were enrolled in the study. Planar GBP was performed with a single-headed gamma camera. From a left anterior oblique projection, data were acquired at 24 frames/cardiac cycle with ECG gating during the equilibrium state. SPET GBP was carried out utilizing a triple-headed gamma camera, with 60 projection views over 360 degrees, with 60 s per view, in 16 frames/cardiac cycle. Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were calculated by using the analysis program. The reproducibility of these values and the correlation between SPET and planar GBP were assessed. To evaluate the effect of cut-off frequencies of a Butterworth filter, six different cut-off frequencies (order=8, 0.3-1.0 Nyquist) were tested with data obtained from 12 patients. The reproducibility of LVEF by SPET GBP was satisfactory (intra-observer, r=0.95; inter-observer, r=0.96), whereas reproducibility of RVEF by SPET GBP was fair (intra-observer, r=0.83; inter-observer, r=0.83). LVEF with SPET GBP was well correlated (y=1.1x+6.62, r=0.85, P<0.01) with LVEF readings of planar GBP. However, LVEF with SPET GBP was overestimated (mean difference of 12) in comparison with that of planar GBP. The RVEF derived from SPET GBP showed poor correlation (y=0.52x+33, r=0.53, P<0.01) with planar GBP. No significant effect of cut-off frequencies of Butterworth filters was evident in the calculation of LVEF and RVEF (P=0.48 and 0.67) with SPET GBP. It is concluded that SPET GBP with QBS is useful for the evaluation of LVEF. However, measurement of the RVEF showed lower reproducibility compared with measurement of the LVEF.

Adolescent↗

Five-minute recording of heart rate variability in severe chronic heart failure: correlates with right ventricular function and prognostic implications.

BACKGROUND: In advanced chronic heart failure (CHF), correlation between heart rate variability (HRV) and parameters of disease severity is still unclear. A reduced HRV has been related to left but not to right ventricular function parameters. Moreover, the prognostic role of spectral measures is not fully defined. We sought to assess HRV by using a short electrocardiographic recording in ambulatory patients with severe CHF to investigate the relation of HRV with clinical neurohormonal and hemodynamic parameters and to determine its predictive prognostic power. METHODS AND RESULTS: HRV was obtained from 5-minute electrocardiographic recordings in 75 ambulatory patients with CHF referred for heart transplantation screening. Standard frequency-domain parameters (total power, low-frequency power, and high-frequency power) were calculated. Prognostic value of these autonomic markers and their correlation with clinical and instrumental parameters were also assessed. A low low-frequency/high-frequency ratio was an independent predictor of cardiac events (P =.015). No correlation was found between New York Heart Association class and HRV, whereas significant correlations were identified between norepinephrine plasma levels, several hemodynamic parameters, and spectral measures (P < or =.03). A reduced HRV, particularly a low-frequency power reduction (P =.000), was highly related to indexes of right ventricular dysfunction. CONCLUSIONS: The current data indicate that spectral analysis of HRV, calculated from short electrocardiographic recordings, may represent a simple but effective means contributing to risk stratification of patients with severe CHF. Autonomic information obtained from this analysis suggests that right ventricular dysfunction may be a critical element determining autonomic imbalance in patients with severe CHF.

Biomarkers↗

High-risk subgroup of inferior myocardial infarction: importance of anterior wall motion and right ventricular function.

To identify high-risk subgroups of inferior myocardial infarction, 75 patients presenting with their first inferior infarction were investigated by sequential gated blood pool scans. The patients were divided into four groups based on the right ventricular function (RVF) and anterior wall motion (AWM) of the left ventricle by scan at the time of admission. A second blood pool scan was performed at ten days to evaluate RV and LV function. Thirty-eight patients had cardiac catheterization before discharge and all patients were followed up for one year to determine their clinical outcome. Depressed RVF and reduced AWM were observed in 26 (35%) (Group A); depressed RVF and normal AWM were found in 20 (27%) (Group B); reduced AWM and normal RVF in 10 (13%) (Group C); and normal RVF and AWM in 19 (25%) (Group D). The mean values of biventricular function (LVEF, RVEF) in groups A, B, C, and D were (44.9 +/- 8.4%, 32.5 +/- 9.9%), (59.9 +/- 8.6%, 34.5 +/- 8.0%), (44.9 +/- 15.7%, 48.2 +/- 3.3%), and (60.4 +/- 9.1%, 51.6 +/- 10.6%), respectively, at admission. In serial measurements, LVEF did not change significantly in any group, however, RVEF improved nearly 10 points in groups A and B at 10 days. Group A also had the highest incidence (82%) of left anterior descending coronary artery involvement, and the highest mean creatine phosphokinase levels (762 +/- 318 U/l): Furthermore, group A had a high incidence of major complications during their hospital course and high mortality during the one-year follow-up. These data clearly identified group A as a high-risk subgroup of patients with inferior infarction.

Coronary Angiography↗

Improved right ventricular function after intra-atrial repair of transposition of the great arteries.

Current interest in the arterial switch operation for simple transposition of the great arteries (TGA) has led us to evaluate our latest patients who have undergone intra-atrial repair. Right ventricular function and overall results were compared in 32 patients who had undergone the Senning procedure between 1978 and 1983 and 26 patients who had undergone Mustard repair between 1971 and 1978). Deep hypothermia and circulatory arrest were used in all Senning operations and in 18 of 26 Mustard procedures. Cardiac catheterization was performed an average of 1 year after surgery in all patients. Postoperative right ventricular ejection fraction (EF) was below normal (less than 0.49) in 16 of 32 patients who underwent the Senning procedure and averaged 0.48 +/- 0.09. In the patients in this group with abnormal right ventricular EFs after repair there was a fall in the value after surgery (0.51 to 0.40, p less than .001), while in those with normal right ventricular EFs after repair there was no change (0.57 to 0.55, NS). All 32 patients who underwent the Senning procedure were compared with 26 patients who underwent the Mustard operation (13 treated between 1971 and 1974 and 13 treated between 1975 and 1978). An older age at surgery (12 +/- 7 vs 6 +/- 8 months, p less than .006) and a lower preoperative right ventricular EF (0.46 +/- 0.09 vs 0.54 +/- 0.08, p less than .007) characterized the Mustard vs the Senning group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗

Adequate preservation of right ventricular function after coronary sinus cardioplegia. A clinical study.

Whether retrograde coronary sinus cardioplegia adequately preserves right ventricular (RV) function is still a point of concern. Using technetium Tc 99m-labeled red blood cells, we assessed global and segmental RV function by first-pass and gated blood-pool radionuclide angiocardiography before and within 24 hours after aortic valve replacement in 14 consecutive patients (age, 58 +/- 5 years; mean +/- SEM). Coronary sinus cardioplegia was given in a multidose fashion at a flow rate of 50-70 ml/min through a balloon-tipped catheter, with the inflated balloon kept seated around the intra-atrial rim of the coronary sinus orifice. Additional myocardial protection was provided by systemic (25 degrees C) and topical hypothermia. Postoperatively, none of the patients had clinical or hemodynamic patterns suggestive of RV dysfunction. The postoperative global RV ejection fraction (0.49 +/- 0.03) was similar to the preoperative value (0.49 +/- 0.01). Analysis of segmental wall motion did not reveal postoperative abnormalities of new onset in any of the three anatomically defined RV regions (free wall, apex, and septum). Similarly, RV end-diastolic and end-systolic volume indexes (ml/m2) were not significantly affected by coronary sinus cardioplegia, being 71.6 +/- 5.8 and 36.1 +/- 3.5 before, and 67.4 +/- 3.8 and 34.5 +/- 2.3 after aortic valve replacement, respectively. We conclude that retrograde coronary sinus cardioplegia does not cause a detectable impairment of RV function if the balloon catheter does not obstruct the terminal tributaries of the coronary sinus and, hence, does not impede delivery of cardioplegia to right-sided cardiac structures.

Adult↗

[Preoperative evaluation of the right ventricular function using the pulsed Doppler echocardiogram in the patients scheduled for the elective pulmonary resection].

Preoperative evaluation of the both right ventricular (RV) systolic and diastolic function using the pulsed Doppler echocardiogram were examined for 46 patients scheduled for the pulmonary resection of the pulmonary tumorous lesions. The parameters which included the RV inflow pattern at the tricuspid orifice and the RV ejection flow pattern at the RV outflow tract were obtained by the pulsed Doppler echocardiogram. Following results were obtained. 1) The RV afterload shown by the parameters of the acceleration time (AT, time beginning of RV ejection to peak velocity) were higher in the aged patients, the low FEV 1% populations, and the patients having the deteriorated left ventricular contraction. 2) The RV diastolic dysfunction were present preoperatively in aged patients over the 60 years old. This phenomenon was characterized by a high degree of atrial contraction and an increased ratio of the peak velocity in atrial contraction phase to that in early rapid filling phase (A/E). When we evaluate the RV inflow and ejection Doppler flow patterns after the major lung resection, these findings must be considerable thing.

Adolescent↗

Augmented right ventricular function in systemic hypertension-induced hypertrophy.

The contractile properties of right ventricular papillary muscles from the hearts of 15 rats which had developed hypertension 6 weeks following renal artery ligation were compared with those from 14 normal litter-mates. In the experimental group, the heart weight-body weight ratio was increased by 39%, while the right ventricular weight-body weight ratio increased 20%. Right ventricular papillary muscles from the hypertensive rats demonstrated increased tension development at the apex of the length-active tension curve (P less than 0 X 0001), elevated maximal rate of tension development (P less than 0 X 001), and increased maximal velocity of contraction at muscle lengths corresponding to both a light preload and at Lmax (P less than 0 X 05). Resting tension and time-to-peak tension in the muscles from the hypertensive group were not significantly different from the normal group. Thus, improved right ventricular performance, in the presence of increased left ventricular afterload, may indicate the existence of a stimulus to increased function in hypertrophied muscle not yet negated by the adverse effects of direct exposure to stress.

Animals↗

Right ventricular function during weaning from mechanical ventilation after coronary artery bypass grafting: effect of volume loading.

OBJECTIVE: The study was designed to investigate the right ventricular (RV) reaction to weaning from mechanical ventilation (MV) in patients with and without volume loading after coronary artery bypass grafting (CABG). DESIGN: Controlled study. SETTING: Surgical intensive care unit in a university hospital. PATIENTS: 18 patients were randomized in two groups, Control group (n = 9) and Volume group (n = 9), when the established criteria for weaning from the respirator were satisfied. INTERVENTION: During MV, patients in the Volume group received in rapid (10-min) 6 ml/kg infusion of a 6% hydroxyethyl starch preparation. MEASUREMENTS AND RESULTS: Hemodynamic parameters were measured using a combined right ventricular (RV) ejection fraction-oximetry pulmonary artery catheter at T0 (during MV: baseline), T1 (during MV: 10 min after volume loading or at the same time in the Control group), T2 [after 20 min of spontaneous ventilation (SV)]. In the Control group, RV volumes did not differ throughout the study, while cardiac index (CI) and RV stroke work index (RVSWI) increased from T1 to T2. In the Volume group, RV volumes increased from T0 to T1, further increasing from T1 to T2, whereas CI increased only from T0 to T1. In this group, RVSWI increased from T0 to T1 in 8/9 patients and from T1 to T2 in 6/9 patients. CONCLUSIONS: An increase in RV volumes with a concomitant increase in RVSWI was observed in high preload patients when going from MV to SV, suggesting a preserved RV function during weaning from MV in this group compared with control patients. The depression in RV contractility observed in some patients suggested that rapid volume expansion before weaning from MV in CABG patients must be done carefully.

Aged↗

AT1 receptor antagonist therapy preferentially ameliorated right ventricular function and phenotype during the early phase of remodeling post-MI.

1. The influence of AII on contractile dysfunction, regulation of the tyrosine kinase-dependent signaling molecule extracellular signal-regulated kinase (ERK), and natriuretic peptide gene expression were examined in the noninfarcted left ventricle (NILV) and right ventricle (RV) during the early phase of remodeling post-myocardial infarct (MI) in the rat. The selective AT(1) receptor antagonist irbesartan was administered <10 h following coronary artery ligation, and rats were killed either at 4-day or 2-week post-MI. 2. At 4 days post-MI, left ventricular systolic pressure (LVSP: sham=125+/-12, MI=91+/-4 mmHg) was decreased, whereas left ventricular end-diastolic pressure (LVEDP: sham=9+/-2, MI=17+/-2 mm Hg), right ventricular systolic (RVSP: sham=26+/-1, MI=34+/-2 mm Hg), and end-diastolic pressures (RVEDP: sham=3+/-0.5, MI=7+/-1 mm Hg) were increased. ERK phosphorylation was significantly elevated in the NILV and RV. 3. Irbesartan (40 mg x kg(-1)/day(-1)) administration did not improve left ventricular function, or suppress increased ERK phosphorylation in the 4-day post-MI rat. By contrast, irbesartan therapy normalized RVSP (MI+irbesartan=25+/-1 mm Hg), RVEDP (MI+irbesartan=3+/-0.3 mm Hg), and reduced ERK1 (MI=3.0+/-0.6, MI+irbesartan=2.0+/-0.3-fold increase), and ERK2 (MI=3.8+/-0.8, MI+irbesartan=2.2+/-0.5-fold increase) phosphorylation. 4. In 2-week post-MI rats, biventricular dysfunction was associated with increased prepro-ANP, and prepro-BNP mRNA expression. Irbesartan therapy normalized RVSP, attenuated RVEDP, and abrogated natriuretic peptide mRNA expression (prepro-ANP; MI=9+/-2, MI+irbesartan=2+/-1-fold increase, prepro-BNP; MI=6+/-2, MI+irbesartan=1+/-1-fold increase), whereas both transcripts remained elevated in the NILV despite the partial attenuation of LVEDP. 5. These data suggest that the therapeutic benefit of irbesartan treatment during the early phase of remodeling post-MI was associated with the preferential amelioration of RV contractile function and phenotype.

Angiotensin II Type 1 Receptor Blockers↗

[Assessment of right ventricular function in patients with congenital heart defects with pulmonary hypertension. The role of some parameters of hemodynamics].

Intracardiac hemodynamics was studied in 46 patients with intraventricular septal defect and 32 patients with incomplete atrioventricular canal. The study confirmed practical value of assessment of contractility of right ventricular myocardium basing on information obtained during prolonged catheterization of the right cardiac chambers, construction of right ventricular function curves and analysis of pressure-volume loops. Compared with conventional hemodynamic monitoring this approach to analysis of intracardiac hemodynamics provided real time assessment of cardiac function, facilitated elucidation of causes of lowering of cardiac output and elaboration of optimal pathways of regulation of the myocardial contractile state.

Child↗

[The characteristics of right ventricular function in patients with essential hypertension].

Two-dimensional and pulsed Doppler echocardiography were used to evaluate the function of right ventricule in 166 patients with essential hypertension and the results were compared with those of 79 normal subjects. The pulmonary artery peak flow velocity in 100 patients without left ventricular hypertrophy (LVH) had no significant difference with that of normal controls (0.65 +/- 0.17 vs 0.63 +/- 0.18, P greater than 0.05). The tricuspid early peak flow velocity (E) decreased (0.43 +/- 0.08 vs 0.46 +/- 0.12, P less than 0.01) but the late peak flow velocity (A) increased (0.30 +/- 0.09 vs 0.24 +/- 0.06, P less than 0.001). E/A reduced also (1.57 +/- 0.53 vs 2.02 +/- 0.78, P less than 0.01). The pulmonary peak flow velocity in 66 patients with LVH elevated markedly as compared with those without LVH (0.71 +/- 0.18 vs 0.65 +/- 0.17, P less than 0.001), A increased (0.34 +/- 00.10 vs 0.30 +/- 0.09, P less than 0.001) and E/A decreased (1.29 +/- 0.37 vs 1.57 +/- 0.53, P less than 0.001). The decrement of E/A correlated with the thickness of interventricular septum and the left ventricular mass (r = -0.68 and -0.60 respectively, P less than 0.01). The results show that the diastolic function of right ventricule was damaged in the early stage of essential hypertension but the systolic function remains unchanged. The diastolic function decreased and the systolic function increased further concomitantly with the development of LVH.

Adult↗

[Right ventricular function assessed by scintigraphy using continuous infusion of krypton-81 m].

Scintigraphy using continuous infusion of krypton-81m, (81mKr) is a reproducible, noninvasive method for determining right ventricular ejection fraction (RVEF). Radionuclide determinations of RVEF by 81mKr scintigraphy were compared with those by the technetium-99m (99mTc) first-pass technique in 25 patients; the results obtained by both methods correlated well (r = 0.86, p less than 0.005). In 20 additional patients, the RVEF determined by 81mKr was compared with the RVEF as measured by multislice ECG-gated cardiac X-ray computed tomography, and there was good correlation between RVEFs obtained by the two methods (r = 0.76, p less than 0.005). Furthermore, the RVEF by the 81mKr technique and the LVEF by the 99mTc gated blood pool technique were compared with hemodynamic measurements. There was a significant inverse correlation between RVEF and pulmonary artery pressure or total pulmonary resistance. Other determinants of right ventricular systolic function were the presence of proximal right coronary artery disease, reduced left ventricular function and associated tricuspid regurgitation.

Heart↗

[Right ventricular function in cardiovascular disease evaluated by magnetic resonance imaging].

The usefulness of ECG-gated magnetic resonance imaging (MRI) in evaluating right ventricular architecture and function was assessed by measuring right ventricular wall thickness, wall motion, and areas of the right ventricular cavities of seven normal subjects and 46 with cardiac disease, including atrial septal defect (ASD: six cases), hypertrophic cardiomyopathy (HCM: 19), dilated cardiomyopathy (DCM: eight), and old myocardial infarction (OMI: 13 cases). A superconductive MRI system was used. Transverse images at the level of the tricuspid valve were obtained for measurements. ECG-gated MRI clearly showed the right ventricular myocardium throughout the cardiac cycles and facilitated measuring wall thickness and cross-sectional areas of the right ventricular cavity in all subjects. In normals the mean value and standard deviation of the anterior wall thickness of the right ventricle and the area index of the right ventricular cavity at end-diastole were 3.4 +/- 0.7 mm and 10.6 +/- 1 cm2/m2, respectively. The anterior and lateral walls and tricuspid annulus moved inward to the right ventricular cavity in systole, and the excursion of the lateral wall and tricuspid annulus was larger than those of the anterior wall. The interventricular septum (IVS), however, moved outward to the left ventricle in systole. The anterior wall thickness of the right ventricle in patients with HCM was 5.8 +/- 1.4 mm thicker than that of normal subjects. In contrast to normals, the area index of the right ventricular cavity was larger in patients with ASD (18.4 +/- 5.4 cm2/m2) and smaller in patients with HCM (9.1 +/- 1.6 cm2/m2). The IVS moved inward in all patients with ASD and in several patients with HCM. The anterior and lateral wall motion was decreased in patients with ASD and DCM.

Adult↗